Modified lamellar keratoplasty and immunosuppressive therapy guided by in vivo confocal microscopy for perforated Mooren's ulcer.

ABSTRACT

AIM: To observe the efficacy of modified lamellar keratoplasty (LK) and immunosuppressive therapy guided by in vivo confocal microscopy (IVCM) for perforated Mooren's ulcer. METHODS: 25 patients (31 eyes) with perforated Mooren's ulcer underwent modified LK. The perforated hole was patched with a thin, fresh posterior cornea containing the endothelium, before a glycerin-preserved lamellar graft shaped like the defect was placed. Immunosuppressants and corticosteroids were used and their dosages adjusted following the density of dendritic cells in the corneal graft postoperatively as detected by IVCM. The anatomical recovery, visual acuity, surgical complications, and recurrence were followed up for 24 months. RESULTS: Favourable anatomical recovery was achieved in 27 eyes (87.1%). The vision was significantly improved in all eyes (p<0.05). Four eyes (12.9%) had leakage at the graft-host interface. No allograft autolysis or immunological rejection was observed. A large number of dendritic cells existed in the peripheral and central graft at 1 week postoperatively, with a mean density of 359.47±97.21 cells/mm(2) and 216.93±57.86 cells/mm(2), respectively, which significantly decreased to 93.83±31.07 cells/mm(2) and 43.65±28.43 cells/mm(2) at 2 months. Accordingly, the dosage of medication was gradually reduced during this period. At 6 months, if no dendritic cells were found in the graft, use of the topical drug was stopped. The disease recurrence rate was 9.7%. CONCLUSIONS: Modified LK, combined with immunosuppressive therapy, can effectively treat perforated Mooren's ulcer, with few complications. The use of corticosteroids and immunosuppressants guided by IVCM may reduce the disease recurrence.